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Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

To review the maternal and fetal outcome of triplet, quadruplet and quintuplet gestations following ART, which were managed at a hospital over 11 years.

Study design

Retrospective chart review of 150 triplet, 27 quadruplet, and 6 quintuplet pregnancies between January 2001 and December 2011. 25 women aged 50–56 years with triplet pregnancies, were excluded due to lack of data. No prophylactic interventions were used.

Results

300 triplets, 108 quadruplets, and 30 quintuplets were born. The mean maternal age was 30.2 years (SD 4.2 years). Mean gestational age delivery was 32.2 weeks (SD 4.2 weeks). Maternal complications included preterm labor 114 (86 %), prematurity 115 (87 %), anemia 44 (33 %) gestational diabetes 35 (27 %), preeclampsia 33 (25 %), post partum hemorrhage 13 (10 %). Preterm labor was diagnosed in 84 (84 %) triplets, 32 (97 %) of quadru- and quintuplet pregnancies (P > 0.05). Prematurity and preterm labor were major determinants. Of the 438 fetuses born there were 57 (13 %) still births, 77 (18 %) neonatal deaths. 32 (7 %) were early neonatal deaths, 45 (10 %) late neonatal deaths. The majority died due to extreme low birth weight. 75 (17 %) neonates had low apgar score of <7 at 5 min. 22 (5 %) infants had congenital anomalies. Severe respiratory distress syndrome, perinatal asphyxia, very early preterm delivery and perinatal mortality were higher in quadru- and quintuplets (P < 0.05).

Conclusion

Preterm labor and preterm prematurity were the commonest complications. Neonatal mortality and morbidity was significantly increased in quadru- and quintuplets. Prophylactic interventions were not used in an attempt to prevent preterm labor.

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References

  1. Hernández-Herrera RJ, Ramírez-Sánchez LF (2010) Impact of perinatal mortality in multiple pregnancies over total perinatal mortality in a hospital in Monterrey. Nuevo León 78(7):352–356

    Google Scholar 

  2. Arlettaz Mieth R, Ersfeld S, Douchet N, Wellmann S, Bucher HU (2011) Higher multiple births in Switzerland: neonatal outcome and evolution over the last 20 years. Swiss Med Wkly 141:13308. doi:10.4414/smw

    Google Scholar 

  3. Fell DB, Joseph KS (2012) Temporal trends in the frequency of twins and higher-order multiple births in Canada and the United States. BMC Pregnancy Childbirth 12:103

  4. Devine PC, Malone FD, Athanassiou Achilles, Harvey Karen et al (2001) Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatol 18(4):225–235

    Article  PubMed  CAS  Google Scholar 

  5. McClamrock HD, Jones HW Jr, Adashi EY (2012) Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic. Fertil Steril 97(4):802–809

    Article  PubMed  Google Scholar 

  6. Mansouri HaifaaA, Ghqzqwi AfafH (2007) The maternal and neonatal outcome of high order gestation at King Addulaziz University Hospital. Arch Gynecol Obstet 275:89–92

    Article  PubMed  Google Scholar 

  7. Cutting R, Denton J, Rutherford A (2011) Multiple births: an update. Human Fertil 14(3):149–150

    Article  Google Scholar 

  8. Janvier A, Spelke B, Barrington KJ (2011) The epidemic of multiple gestations and neonatal intensive care unit use: the cost of irresponsibility. J Pediatr 159(3):409–413

    Article  PubMed  Google Scholar 

  9. Umeora OU, AneziOkoro EA, Egwuatu VE (2011) Higher-order multiple births in Abakaliki, Southeast Nigeria. Singapore Med J 52(3):163–167

    PubMed  CAS  Google Scholar 

  10. Adegbite Al, Ward BS, Bajoria R (2007) Perinatal outcome of quadruplet pregnancies in relation to chorionicity. J Perinatol 27:15–21

    Article  PubMed  CAS  Google Scholar 

  11. John T. Queenan, Catherine Y. Spong, Charles J. Lockwood et al (2012) Multiple Gestations, chap. 39. In: Queenan’s management of high-risk pregnancy: an evidence-based approach. 6th edn, Published Online: 4 Jan doi:10.1002/9781119963783.ch39

  12. Skrablin Snezana, Kuvacic Ivan, Pavicic Dinka, Drzisalav et al (2000) Maternal neonatal outcome in quadruplet and quintuplet versus triplet gestation. Eur J Obstet Gynecol Reprod Biol 88:147–152

    Article  PubMed  CAS  Google Scholar 

  13. Al-Sulaiman SA, Al-Jama FE, Rahman J, Rahman MS (2006) Obstetric complications and perinatal outcome in triplet pregnancies. J Obstet Gynecol 26(3):200–204

    Article  Google Scholar 

  14. Maksheed M, Al-Sharan M, Egbase P, Al-Essa M et al (1998) Maternal and perinatal outcomes of multiple pregnancy following IVF-ET. Int J Gynecol Obstet 6(2):155–163

    Article  Google Scholar 

  15. Macones GA, Schemmer G, Pritts E, Weinblatt V, Wapner RJ (1993) Multifetal reduction of triplets to twins improves perinatal outcome. Am J Obstet Gynecol 169:982–986

    Article  PubMed  CAS  Google Scholar 

  16. Battin M, Wise M, de Zoete A, Stone P (2009) Infant and perinatal outcome of triplet pregnancy in Aukland: better than expected? J NZMJ 122(1298):39–47

    Google Scholar 

  17. Newman RB, Hamer C, Miller MC (1989) Outpatient triplet management: a contemporary review. Am J Obstet Gynecol 161:547–555

    Article  PubMed  CAS  Google Scholar 

  18. Spencer JV, Ingardia CJ, Christopher J et al (2009) Perinatal and neonatal outcomes of triplet gestations based on placental chorionicity. Am J Perinatol 26(8):587–590

    Article  PubMed  Google Scholar 

  19. Abu Heija AT (2003) The maternal and neonatal outcome of high order gestation. Arch Gynecol Obstet 268(1):15–18

    PubMed  Google Scholar 

  20. Cassel KA, O′connell CM, Baskett TF (2004) The origins and outcome of triplet and quadruplet pregnancies in Nova Scotia 1980 to 2001. Am J Perinatol 21(8):439–445

    Article  Google Scholar 

  21. Zuppa AA, Scorrano A, Cota F, Andrea V, Fracchiolla A, Romagnoli C (2007) Neonatal outcomes in triplet pregnancies: assisted reproduction versus spontaneous conception. J Perinat Med 35:339–343

    Article  PubMed  Google Scholar 

  22. Bajoria R, Ward S, Adegbite A (2006) Comparative study of perinatal outcome of dochorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 194:415–424

    Article  PubMed  Google Scholar 

  23. Adegbite AL, Ward SB, Bajoria R (2005) Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 193:1463–1471

    Article  PubMed  Google Scholar 

  24. Savona Ventura C, Gatt M, Vella K, Grima S (2008) Higher order multiple pregnancy outcomes in the Maltese islands 2000–2004. Malta Med J 20(1):19–23

    Google Scholar 

  25. Cook JL, Geran L, Rotermann M (2011) Multiple births associated with assisted human reproduction in Canada. J Obstetrics Gynaecol Can 33(6):609–616

    Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, P.O. Box 24923, Kuwait, 13110, Kuwait

    Rachana Chibber & Asiya Tasneem Mohammed

  2. Department of Obstetrics and Gynecology, Al-Adan Tertiary Hospital, Kuwait, Kuwait

    Rachana Chibber, Mohamed Fouda, Wael Shishtawy, Mariam Al-Dossary, Jassim Al-Hijji & Ali Amen

Authors
  1. Rachana Chibber
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  2. Mohamed Fouda
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  3. Wael Shishtawy
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  4. Mariam Al-Dossary
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  5. Jassim Al-Hijji
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  6. Ali Amen
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  7. Asiya Tasneem Mohammed
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Correspondence to Rachana Chibber.

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Chibber, R., Fouda, M., Shishtawy, W. et al. Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study. Arch Gynecol Obstet 288, 759–767 (2013). https://doi.org/10.1007/s00404-013-2796-x

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  • DOI: https://doi.org/10.1007/s00404-013-2796-x

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